CAJ | 학술논문

目的总结输尿管上段结石合并尿路感染的微创治疗经验.方法回顾性分析2009年12月至2013年12月收治的40例输尿管上段结石合并尿路感染患者的临床病历资料,并结合文献进行总结.结果一期膀胱镜下逆行插管21例、B超引导下行经皮肾穿刺造瘘11例,2～6d后感染均得到控制,上述32例患者二期行体外冲击波碎石(ESWL)、经尿道输尿管镜碎石术(URL)或经皮肾取石术(PCNL)治疗成功.其余8例在抗感染同时一期行URL成功.所有患者均无输尿管穿孔、撕裂、尿源性脓毒血症及严重出血等并发症,术后2～ 10周输尿管结石全部排净,平均住院时间13.4 d.结石排净后随访1～12个月,平均6个月.其中3例术前肾功能不全接受URL患者肾功能改善,余肾功能均恢复正常.结论一期膀胱镜下逆行插管或经皮肾穿刺造瘘联合二期行ESWL、URL或PCNL治疗输尿管结石合并尿路感染,并发症少,可迅速控制感染,彻底清除结石,二者联合应用是输尿管上段结石合并尿路感染的理想治疗方法.
목적 총결수뇨관상단결석합병뇨로감염적미창치료경험.방법 회고성분석2009년12월지2013년12월수치적40례수뇨관상단결석합병뇨로감염환자적림상병력자료,병결합문헌진행총결.결과 일기방광경하역행삽관21례、B초인도하행경피신천자조루11례,2～6d후감염균득도공제,상술32례환자이기행체외충격파쇄석(ESWL)、경뇨도수뇨관경쇄석술(URL)혹경피신취석술(PCNL)치료성공.기여8례재항감염동시일기행URL성공.소유환자균무수뇨관천공、시렬、뇨원성농독혈증급엄중출혈등병발증,술후2～ 10주수뇨관결석전부배정,평균주원시간13.4 d.결석배정후수방1～12개월,평균6개월.기중3례술전신공능불전접수URL환자신공능개선,여신공능균회복정상.결론 일기방광경하역행삽관혹경피신천자조루연합이기행ESWL、URL혹PCNL치료수뇨관결석합병뇨로감염,병발증소,가신속공제감염,철저청제결석,이자연합응용시수뇨관상단결석합병뇨로감염적이상치료방법.
Objective To summarize the experience of minimally invasive treatment in upper ureteral calculi complicated with urinary tract infection.Methods Retrospectively analyzed the clinical data of 40 cases with upper ureteral calculi complicated with urinary tract infection who were treated from December 2009 to December 2013.Results Twenty-one cases were performed with retrograde catheterization at cystoscopy and 11 cases were performed with percutaneous nephrostomy directed by B-ultrasound in the stage Ⅰ,the infection were controlled after operation 2-6 d.These patients were successfully cured by extracorporeal shock-wave lithotripsy (ESWL),ureterorenoscope lithotripsy (URL) or percutaneous nephrolithotomy (PCNL) in the stage Ⅱ].The remaining 8 cases were successfully cured by URL with antiinfection therapy in the stage Ⅰ.All patients had no ureteral perforation,laceration,urine derived sepsis and severe bleeding complications.All of ureteral calculi were drained after 2-10 weeks.The average hospital stay was 13.4 d.Patients were followed up for 1-12 months after the stone expulsion,the average was 6 months.There was 3 patients who with preoperative renal dysfunction had been improved after URL,and other patients' renal function returned to normal.Conclusions The therapy of retrograde catheterization at cystoscopy and percutaneous nephrostomy directed by B-ultrasound in the stage Ⅰ,combined with ESWL,URL or PCNL in the stage Ⅱ in treating upper ureteral calculi complicated with urinary tract infection have more advantage such as less complication,rapid control of infection and complete removal of stones.It is an ideal method.